Help-Seeking Patterns Among Taiwanese With Schizophrenia
Help-seeking for mental health concerns involves recognition, naming/attribution, considering treatment options, and treatment appraisal. In Taiwan, a pluralistic care system – western psychiatry, Chinese medicine, and indigenous healing – is available for mental health concerns, so help-seeking choices are further complicated by social values and cultural beliefs. Guided by the Cultural Determinants of Help Seeking model developed by Saint Arnault (2009), we focus on attributions of schizophrenia representing social significance of the mental health concern and perceptions of mental illness stigma as exchange rules of help-seeking in the Taiwanese cultural context. We aim to identify endorsement patterns of attribution and stigma in relation to the types of care Taiwanese with schizophrenia pursued. The result will deepen understandings of social-cultural influences on help-seeking behavior.
We used a cross-sectional design and recruited 212 adult Taiwanese with schizophrenia-spectrum disorder through Taiwanese Alliance for Mentally Ill, 3 community rehabilitation centers, and 3 psychiatric hospitals in the northern and southern regions of Taiwan between July 2012 and March 2013. Participants filled out a survey in Chinese containing demographic information, measures of mental illness attributions (including psychodynamic, biological, environmental, moral, and supernatural attributions), perceived and internalized stigma, and work alliance with and information received from care providers, as well as questions of their help-seeking trajectory, including age of first recognition of concerns and types of care first pursued and currently received. We conducted descriptive statistics and t-tests for analysis.
Of the 212 participants, 36.3% (n=77) had sought help from a Chinese medicine doctor, 49.1% (n=104) had sought help from an indigenous healer, and 98.1% (n=207) had sought help from a doctor practicing western psychiatry. Approximately 56% (n=119) of the participants who first sought only western psychiatric care were under exclusive western psychiatric care at the time of study. When compared with the rest of the sample (participants who used exclusive other types of care or used multiple types of care at one or both of the two time-points), this group had overall lower endorsement of all items of attribution when first recognizing mental health concerns. Particularly, this group was significantly lower on some supernatural attributions (p=.010 to p=.031) and some biological attributions (p=.007 to p=.047). When compared with the rest, the group experienced significantly less perceived stigma (p=.023) and the alienation domain of internalized stigma (p=.019), although no other significant difference was found regarding internalized stigma. There was no significant difference between this group and the rest on their experiences with any of the three types of care regarding work alliance and information/education. Finally, there was no statistically significant difference between the two groups regarding age, sex, education, employment, household income, perceived health, and age of first recognition of concerns.
Our findings suggest choices of care associated with patterns of attributions and perceptions of stigma rather than experiences with care or demographic conditions. Practice and service programming need to enhance education about mental illness and combating stigma. Future research needs to focus on the factors of social-cultural context in help-seeking.